Mental Health Recovery Newsletter

Introduction

Welcome to Mental Health Recovery Newsletter, begun in March 2000 and published quarterly from the office of Mary Ellen Copeland. This newsletter is for people who experience psychiatric symptoms, for family members and health care professionals, and for anyone who wants to learn more about recovering from uncomfortable, often disabling psychiatric symptoms. It can be sent to you by mail or by e-mail. You can also have it sent to others. Please contact us and let us know whether we can send you the email version to save a tree. We will be letting you know about books, seminars, and other news, and will feature a recovery topic and at least one wellness tool in each issue.

If you would like a copy of previous issues of this newsletter or would like to enter your free subscription, please contact the office of Mary Ellen Copeland by phone or e-mail or click here.

Seminar Schedule

Mental Health Recovery Seminar I: Learning Mental Health Recovery including Wellness Recovery Action Planning

July 10-12, 2001 Come to Vermont and learn recovery skills from Mary Ellen Copeland and her staff. This training is specfically designed to teach basic recovery skills to people who want to use them to enhance their own recovery, and/or teach them to others. In this training you learn key recovery concepts, skills and tools, and develop your own Wellness Recovery Action PlanT. This seminar is open to people who experience psychiatric symptoms, to their families and supporters, to health care providers and to anyone interested in learning more about mental health recovery. The cost of this training is $600 including all materials and texts.

Mental Health Recovery Correspondence Course

The four-part Mental Health Recovery Correspondence Course is offered as an alternative to attending Mental Health Recovery Seminar 1: Learning Mental Health Recovery including Wellness Recovery Action Planning. Participants who successfully complete this course are eligible to attend Mental Health Recovery Seminar II: Facilitator Training. However, many people who do not plan to receive further training have taken this course as a way to enhance their own recovery.

The course is designed to be completed in four weeks and must be started at least four weeks before Seminar II if you are using it as your prerequisite requirement. If you are not doing the course as a prerequisite to Seminar II, you can work at whatever pace you choose.

The topics to be covered include:

• underlying recovery concepts, including hope, personal responsibility, education, self-advocacy, peer support, family support, professional support; possible medical causes of psychiatric symptoms; and medication management;
  
  
• the use of various simple, safe, self-help wellness tools that people who experience psychiatric symptoms have found to be useful in relieving these symptoms and for maintaining wellness, including peer counseling, focusing exercises, relaxation and stress-reduction, journaling, controlling stimulation, diversionary activities, dietary considerations, exercise, sleep and daily planning;
  
  
• developing a Wellness Recovery Action PlanT that includes
  1) a Daily Maintenance plan,
  2) identifying and responding to Triggers,
  3) identifying and responding to Early Warning Signs of increased difficulty,
  4) identifying those symptoms that indicate the situation has worsened and Things Are Breaking Down, and responding to those symptoms to successfully relieve them, and
  5) writing an effective Crisis Plan or advanced directive; · specific issues that affect wellness, including changing negative thoughts to positive ones, building self-esteem, suicide prevention, reducing the effects of trauma, and developing a lifestyle that enhances wellness.

It is anticipated that course participants will spend four to five hours per week for four weeks, reading and completing assignments. The work would be enhanced by regular meetings with other course participants, but this is not a course requirement.

The course includes specific reading assignments, articles, projects, activities and discussion with the instructor or a member of her staff. The texts for the course are:

• Copeland, M. E. 1992. The Depression Workbook. Oakland, CA: New Harbinger Publications.
  
  
• Copeland, M. E. 1994. Living Without Depression and Manic Depression. Oakland, CA: New Harbinger Publications.
  
  
• Copeland, M.E. 1997/2000. Wellness Recovery Action PlanT. W. Dummerston, VT: Peach Press.

The cost is $200 per participant, plus the cost of any texts you need to purchase.

Mental Health Recovery Seminar II: Facilitator Training

May 21-25, 2001, Brattleboro, VT. Mary Ellen Copeland will lead a Facilitator Training designed to train people to teach and network Mental Health Recovery information, including how to develop a Wellness Recovery Action PlanT. Candidates for this training include people who have experienced psychiatric symptoms, family members, and health care providers. The Seminar is based on:

1) the findings of Mary Ellen Copeland's studies on how people relieve psychiatric symptoms on a daily basis and how they get well, stay well and move on to do the things they want to do with their lives; and

2) data that shows how to most effectively share this information with those people who can most benefit from it.

The prerequisite for this training can be satisfied through:

1) prior in-depth experience with Mary Ellen's work;

2) satisfactory completion of Mental Health Recovery Seminar I; or

3) satisfactory completion of the four-lesson Correspondence Course described above.

Continuing Education Units to meet professional development requirements are available for these seminars at no extra charge. Three master's level course credits are available from Vermont College for participants who are willing to do the additional assignments necessary to meet the course requirements and pay the $75 per credit fee ($225 total).

The following issues will be addressed through presentations, demonstrations, interactive discussion and related activities:

• Recovery skills and strategies review
• supporting and motivating people in learning and using Recovery/Self-Management skills
• the importance of sharing and networking Recovery information
• effective ways of teaching Recovery information to people who experience psychiatric symptoms, to their supporters, and to health care providers;
• effective information networking strategies
• introduction to new program initiatives

As a result of this and other similar trainings, it is expected that, over time, we will see:

1. a significant reduction in the need for mental health and emergency services as people with psychiatric symptoms effectively take responsibility for their own wellness and stability, manage and reduce their symptoms using a variety of self-help techniques, and effectively use the support of a network of family members, friends and health care providers; and

2. an increased ability of people with psychiatric symptoms to meet life and vocational goals, enhance their lives, and feel good about themselves.

The cost of this seminar is $900 including the new facilitator's manual.

Mental Health Recovery Seminar III: Facilitator Refresher

April 17-19, 2001, Brattleboro, Vermont. This new three-day refresher course is for anyone who has attended Mental Health Recovery Seminar II or its equivalent. This was arranged in response to requests from trainers. This course, led by Mary Ellen Copeland with assistance from her staff, will:

1) introduce participants to the revised trauma section of the curriculum,

2) describe a special recovery segment focused on issues related to depression and the elderly,

3) address issues related to diversity and recovery,

4) provide an update on Wellness Recovery Action Planning teaching issues.

There will be ample time for problem solving around specific issues. The cost for the training is $500.

Upcoming Presentations

• February 5-15, 2001. Auckland, New Zealand. Eight days of basic mental health recovery and facilitator training, for people who experience psychiatric symptoms and for health care providers.
• March 1-2. Great Falls, MT. Mental Health Association of Great Falls Annual Conference. Keynote addresses: "Mental Health Recovery: The Future Is Now" and "Wellness Recovery Action Planning." Breakout sessions on Crisis Planning, Developing a Wellness Toolbox, and Issues Related to Trauma.
  
  
• March 20-23. Washington D.C. Mental Health Recovery Seminar II: Facilitator Training April 5. Boston, MA. Psychiatric Nursing Conference, "Recovery from Trauma and Abuse."
  
  
• May 3-6. ISOM 30th Annual Conference, (International Society of Orthomolecular Medicine). Concert Hall, Royal York Hotel, Toronto, Ontario. Mary Ellen's presentation is Friday, 7-9:30 p.m. Open to the public, $20 at the door. (The word "orthomolecular" means "correct the molecules," and is a "restorative medicine" approach.) For more information contact Steven Carter, Journal Of Orthomolecular Medicine, 416-733-2117.

New Resources

Wellness Recovery Action PlanT (WRAP) FOR DUAL DIAGNOSIS

A WRAP Workbook adapted for people with a dual diagnosis of psychiatric illness and addictive disorder.
By Mary Ellen Copeland, MS, MA

Based on the book Wellness Recovery Action PlanT (Copeland, M.E., Brattleboro, VT: Peach Press, 1997, revised 2000) this new resource was initiated by, and developed with input from, "The Integrated Recovery Project" in Athens, Ohio. It provides a guide to developing a personal Wellness Recovery Action PlanT in a workbook format, including forms for each part of the plan. Copies are available now for $10 each and may be ordered from Mary Ellen Copeland's office using the enclosed form. (Discounts available for orders of 10 or more.)

WELLNESS TOOLBOX

Personal responsibility is key to using any wellness tool. It is up to you to notice how this tool is making you feel, to decide whether or not you want to use it, and how much use of this tool is best for you. For instance, some people find that just a little light exposure each day is helpful to them, some find they need much more light exposure, even several hours, and some people find that light exposure or too much light exposure makes them anxious, agitated and irritable. As with any other tool, you may notice that sometimes exposure to light helps you to feel better and sometimes it does not.

Light
by Mary Ellen Copeland

Have you noticed that you feel worse in the fall and winter or when the weather is cloudy and bleak? A condition commonly referred to as Seasonal Affective Disorder or SAD may be responsible. More people who live in the north in thenorthern hemisphere or the south in the southern hemisphere experience SAD.

Scientists have found that exposure to sunlight through the eyes helps some people feel better by affecting the activity of neurotransmitters in the brain. Many people have found that including daily exposure to outdoor light in their Wellness Recovery Action PlanT has helped them relieve symptoms of SAD, symptoms like generalized feelings of sadness, fatigue, lack of motivation, excessive sleep and cravings for sweet foods that occur when there is less light. Some people are using specially designed light boxes to increase their daily exposure to light.

About ten years ago, my doctor suggested I try light therapy as a way of dealing with recurrent episodes of winter depression. I was skeptical, so I attended a workshop on light therapy led by a physician who had studied the effects of increased exposure to outdoor light, the use of supplemental full spectrum lighting, as well as the use of light boxes. I was intrigued. According to his instruction, I tried light therapy by purchasing a shop light fixture and replacing the fluorescent bulbs with fluorescent grow lights. I set it on the table in the room where I worked and voila! I felt better. So I purchased two more shop light fixtures, again replaced the bulbs and had my son mount the three light fixtures on a piece of plywood. I now had a primitive light box. I began noticing I was feeling much better. Since then, I have purchased a light box because it is more portable. It provides the light in my office through the winter and on cloudy days. Exposure to outdoor light or my light box is now part of my daily maintenance plan in the "Do I need to...." section. If I start to experience early warning signs of depression, I increase my exposure to light. If I am having racing thoughts and feeling anxious, I reduce my exposure to light. In the winter I find that I must get outdoors for an hour or so each day as well as use my light box to light my working space indoors.

If you think you may have SAD, tell your doctor. He or she may be able to give you helpful information or refer you to a doctor who has expertise in this field. A physician who knows about light therapy will help:

• decide whether you really have SAD;
• make sure light therapy is appropriate for you;
• discover if you have other conditions which need treatment;
• work with you to develop a light exposure schedule that fits your needs and lifestyle;
• help you in monitoring how you are doing;
• provide additional ideas on how you can get more light; and,
• give you needed encouragement and support.

There are some simple, safe, effective things that you can do to help yourself feel better if you have SAD.

1. Spend at least a half-hour outside each day, even on cloudy days. If you are at school or work indoors, try to spend some time outside during your lunch hour. Glasses, sunglasses or contact lenses will block some of the sunlight you need. If you can't see well enough to go for a walk or be involved in some other outdoor activity without glasses, sit on a bench eating your lunch or talking to a friend.
   
   
2. Gazing at the sky helps, but never look directly at sun. The amount of light you get outside is enhanced by reflection off of snow and reduced by reflection off dark objects such as buildings and trees.
   
   
3. Keep your indoor space well lit. Have plenty of lights on. Let in as much outdoor light as possible. Spend as much time as you can in spaces near windows.
   
   
4. Consider using a light box. You can find companies that manufacture and sell light boxes by searching on the internet using the key words light box. If you don't have access to the internet, ask a friend to look it up for you or use the computer at your local library. Light boxes are expensive. If you can't afford one, ask your health insurance company to purchase it for you. Ask your doctor to support you in this effort. You could also ask your local mental health center to purchase a light box and provide a space where you and others can come to get exposure to light. Some mental health centers are providing this valuable service.

Tanning booths which only shed light on the skin are not recommended and may be dangerous!

Some people notice almost immediate relief of symptoms when they begin increasing the amount of light they get through their eyes. It usually takes from 4 to 5 days to work, but may take up to 2 weeks. If you don't feel any better after 2 weeks of treatment with light therapy, your problem is probably not SAD.

For more information on Seasonal Affective Disorder, refer to:

• Copeland, M.E. (Revised 2000) The Depression Workbook. Oakland, CA: New Harbinger Publications.
• Rosenthal, N. (1989) Seasons of the Mind. New York: Bantam Books.
• Rosenthal, N. (1993) Winter Blues: Seasonal Affective Disorder: What It Is & How to Overcome It. New York: Guilford Press.

If you have medical problems like diabetes, hypoglycemia or heart disease, adhere strictly to the diet prescribed by your doctor. You will be the beneficiary.

RECOVERY TOPICS

Motivation
by Mary Ellen Copeland

Recovery from severe and persistent psychiatric symptoms is a daunting task. You may often feel like giving up, like it's not worth the trouble. All of us feel like that from time to time. It is important to remember that this is absolutely normal. What can you do to motivate yourself when you feel this way?

1. Remind yourself that it is normal to feel unmotivated from time to time - especially when you are working on something that is very hard, when progress may be slow and when you feel that you often have setbacks.
   
   
2. Remember that people who experience psychiatric symptoms take back control of their lives and go on to do the things they want to do and be the kind of person they want to be. It may help to think about people you know or have heard of, even famous people, who have overcome difficult symptoms and gone on to live healthy lives.
   
   
3. Take small steps. Big change doesn't happen overnight. If you have trouble looking people in the eye, and today you looked one person in the eye, that's great. Maybe you feel anxious when you ride the bus and today you rode the bus for two blocks. That is a major achievement.
   
   
4. Spend some time writing your goals. What do you want out of life? How can you best achieve that? Develop a time line for meeting both your short and long term goals. Make sure they are your goals and not goals that someone else has developed for you. Share your goals with your close supporters. Ask them to encourage you as you work to meet these goals.
   
   
5. Give yourself a reward for each accomplishment, even the smallest things. Some examples of simple rewards are: a pat on the back, half an hour reading a good book, taking a short rest, calling for a chat with a good friend, or renting a video for yourself.
   
   
6. Spend some time each day doing things that are easy for you to do, as much as you need to. Don't spend all your time trying to do the hard stuff. Clean out one drawer. Wash the kitchen sink. Take the dog for a walk. Sew on a button. Write one letter or answer one e-mail.
   
   
7. Do things that make you feel good about yourself. Take good care of your personal hygiene. Do something you really enjoy. Do something special for someone else. Tell someone else they are doing a good job. Tell your supporters how much you appreciate their help.

Postpartum Depression and Anxiety
By Sonia Murdock

Kelly felt anxious and overwhelmed after the birth of her daughter. She spent days crying for hours at a time, feeling worthless, unable to cope and guilty that she wasn't happy with her new child. Kelly and her husband had planned for the baby and now she was thinking maybe she had made a mistake. She was losing her appetite, experiencing panic attacks, anxiety and insomnia. Kelly was beginning to think she was going crazy and was afraid to tell anyone she was having a fear of hurting herself and her daughter. She was feeling alone and thinking that maybe everyone would be better off without her.

Kelly is among the (up to) 20% of new mothers who experience postpartum depression or a postpartum mood disorder. Postpartum mood disorders are the number one medical complication related to pregnancy. Postpartum mood disorder describes the range of emotional disorders a woman can experience related to pregnancy like: postpartum depression, postpartum panic/anxiety, postpartum mania, postpartum obsessive-compulsive disorder, postpartum stress. Postpartum psychosis is experienced by 1 or 2 new mothers in every 1,000. The symptoms include confusion, hallucinations, paranoia and delusions. PPP is a medical emergency and requires immediate treatment.

Women experiencing a postpartum mood disorder are not alone, they are not to blame, and they will feel better and get well. It is important to seek out information and treatment to best take care of themselves and their baby.

Women with a personal or family history of depression or an anxiety disorder need to be especially watchful for early warning signs of depression after delivery as they are at highest risk for experiencing postpartum depression. Other factors such as marital discord, financial worries, recent loss/death, poor relationship with own mother, past sexual abuse, alcohol and substance abuse, history of premenstrual syndrome, and infertility can also br contributing factors.

The mission of Postpartum Support International (PSI) is the promotion of international awareness, prevention and treatment of mental health issues related to childbearing. The non-profit, self-help organization provides free of charge telephone support, information and healthcare and support group referrals in your area. They also emphasize the importance of postpartum mood disorder awareness so women, family members and medical professionals can recognize the symptoms and treat the illness.

For information and healthcare and support group referrals in your area, or to become a volunteer, call Postpartum Support International at (805) 967-7636 or check out their website at www.postpartum.net. Postpartum Support International, 927 North Kellogg Ave., Santa Barbara, CA 93111, USA.

Note from Mary Ellen Copeland: If you think you may have postpartum depression, arrange for a complete physical examination right away. You may have a medical condition that needs treatment, such as hypothyroidism, that was caused by the stress of pregnancy. In addition there are many things you can do to help yourself right away. Make sure you are eating healthy foods--limit sugar and caffeine intake. Spend some time every day doing something that you enjoy--painting a picture, playing a musical instrument, reading a good book, or working in your garden. Ask a family member or friend to help with the baby as well as household tasks to give you a break. There are many other Wellness Tools and strategies that will be helpful. They are listed in my books. I recommend you begin with "Winning Against Relapse" (see publications).

Building a Career When Living with a Mood Disorder
By "Sabina Morris"

People with mood disorders often have problems finding and keeping work. In my fifteen-year history of depression, I have found this to be personally true. I have encountered countless people with mental health problems whose careers have been interrupted or even sabotaged by their mental illness.

My own story can serve as an example of how it is possible to overcome even severe depression and become meaningfully employed. After struggling with chronic depression for many years, I was finally hospitalized for depression in 1996 and 1997. My depression was so severe that I had forgotten what year it was. I had stopped eating and lost 30 pounds, to the point that my weight had dropped into the eighties, less than 90 pounds. My psychiatrist said that my depression was the worst case of depression he had seen in 30 years of practising psychiatry. A judge agreed with him and had me forcibly committed to a mental hospital.

When I got out of hospital, I needed to rebuild my life. At first, that meant learning how to live on my own again, how to take care of my basic living needs, run a household, re-establish friendships and a social life. But gradually, that also meant needing to return to the workforce to earn a living.

My resume had large gaps in it, periods of mood instability when I had been unable to work over the last nine years. How would I explain that to an employer?

I began by registering in a Work Adjustment Employment Support program run by a local psychiatric hospital. It was for mental health patients who wanted to return to the workforce. I was placed in a volunteer work placement at the hospital. The volunteer job gave a structure to my day. I had a place to go to every morning. This volunteer job gave me a reason to get out of bed every morning and get dressed. It also gave me some recent work experience to put on my resume.

The volunteer job prepared me for my first paid job since hospitalization. I took on a six-month part-time contract as an office administrator. This led to another six-month full-time contract doing data entry work for the government.

While I was really glad to be working again, I was depressed about the fact that I could not find permanent work in my own field. I had two university degrees and I was working as a file clerk for just above minimum wage. When the contracts ran out, I looked for work really hard but couldn't find anything.

Then one day I read Mary Ellen Copeland's book Living Without Depression & Manic Depression. There was a chapter in it devoted to "Creating a Career That Works." I found the whole book to be inspirational, and this chapter in particular helped me a great deal. It gave me hope to know that there were other people with mood disorders out there who were also struggling over the issue of employment. At the end of the chapter, Mary Ellen listed as a resource the book What Color Is Your Parachute? I went out and bought the book and read it cover to cover.

To sustain me in my job search, I started a job-finding club in my own home. This was a support group for other people who were looking for work. We met every two weeks to discuss job search techniques, job leads and to emotionally support each other in our period of unemployment.

Two things happened that finally helped me to find permanent work again in my field as a professional writer and editor. The first thing I did was to upgrade my computer and the second was to get an Internet account. I began to use the Internet to look for jobs. Through the Internet, I found out about an agency in my city that specialized in helping people with disabilities return to the workforce. I promptly went and registered with them. Although they did not find me a job, I had a one-hour session with an employment counselor who showed me how to re-write my resume to make it sparkle.

While I began getting called to a lot of job interviews, nobody was offering me a job. I obviously needed to improve my interviewing skills. Once more, I went out and bought a book. This time, it was the David Burns book, The Feeling Good Handbook. There was a chapter in it called "How to Give a Dynamic Interview When You're Scared Stiff." Within days of reading this chapter, I had my first successful job interview. It had taken three years since my release from the hospital to find a meaningful career. If I could do it, others can too.

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